Mental Illness Treatment Overhaul
Treatment for millions of mentally ill Americans should go beyond medication to help people find jobs, make friends and otherwise live meaningful lives, a presidential commission recommends in a report that calls for a fundamental overhaul of the system.
In a report being released Tuesday, the commission recommends that people with mental illnesses and their families have a larger say in their course of treatment and says care plans should do more than just treat symptoms of disease.
It also recommends early screening so children with mental disorders can be diagnosed early and get help quicker. And it says innovative treatments and ideas must get into the field as soon as they are proven effective.
"The commission recommends fundamentally transforming how mental health care is delivered in America," said the final report of the President's New Freedom Commission on Mental Health.
"The time has long passed for yet another piecemeal approach to mental health reform," said commission Chairman Michael F. Hogan, director of the Ohio Department of Mental Health. "This report provides the president with a roadmap for that transformation."
Health and Human Services Secretary Tommy Thompson called the report "thorough and thoughtful" and directed the Substance Abuse and Mental Health Services Administration to review its recommendations. That agency's head, Charles Curie, embraced the commission's findings.
"Most of all, the report reminds us that mental illness is a treatable illness and that recovery is possible," Curie said in a statement.
About 5 percent to 7 percent of adults in the United States have a serious mental illness, the commission said, and a similar portion of American children suffer from a serious emotional disturbance.
The commission, which was created by President Bush in April 2002, recommended that each state develop a comprehensive plan for transforming its system of care for the mentally ill. Those systems typically combine institutional and community-based care and are paid for with a combination of state, federal and private dollars.
The report does not recommend spending any new money, but says states should be given more flexibility in using dollars already available through various federal programs if they develop strong plans.
In addition, the report recommends that government encourage better care by paying mental health organizations for treatments and services that are "based on proven effectiveness and consumer preferences — not just on tradition or outmoded regulations."
As it is, critics say, the system responds to crises, simply keeping people on medications and squelching symptoms. Under a new model, counselors would develop a plan to help the patient live a fuller life — including, but not limited to, medication.
That could mean helping someone get training for a job or develop skills to have social or romantic relationships, said Robert Bernstein, executive director of the Bazelon Center for Mental Health Law, an advocate who did not work on the report but applauds its conclusions.
In the past, he said, "The hope was to just manage symptoms." An approach centered on "recovery," as the report recommends, would go further.
"There's plenty of evidence that if you provide tools they can be successful in achieving life goals," Bernstein said. "It's the difference between feeling you're hopelessly ill and having a manageable long-term illness."
Bernstein's group and the other major advocacy organizations for the mentally ill are joining together to lobby Congress and the states to implement the report's recommendations.
"Let today be the turning point," said Richard Birkel, national executive director of the National Alliance for the Mentally Ill. "Let today begin the transformation of a broken system of care to one that provides recovery-oriented, community-based treatment and services that we know will work."
In its report, "Achieving the Promise: Transforming Mental Health Care in America," the commission also recommends that: